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Topic Review
Intraoperative Hypotension—A Proactive Perioperative Hemodynamic Management
Intraoperative hypotension (IH) is a frequent phenomenon affecting a substantial number of patients undergoing general anesthesia. The occurrence of IH is related to significant perioperative complications, including kidney failure, myocardial injury, and even increased mortality. Despite advanced hemodynamic monitoring and protocols utilizing goal directed therapy, our management is still reactive; we intervene when the episode of hypotension has already occurred. This research evaluated the Hypotension Prediction Index (HPI), which is designed to predict and reduce the incidence of IH. The HPI algorithm is based on a machine learning algorithm that analyzes the arterial pressure waveform as an input and the occurrence of hypotension with MAP <65 mmHg for at least 1 min as an output. There are several studies, both retrospective and prospective, showing a significant reduction in IH episodes with the use of the HPI algorithm. However, the level of evidence on the use of HPI remains very low, and further studies are needed to show the benefits of this algorithm on perioperative outcomes.
  • 739
  • 16 Mar 2023
Topic Review
Sugammadex for Rocuronium-Induced Neuromuscular Blockade
Sugammadex (Bridion®, Merk Sharp and Dohme Corp., Kenilworth, NJ, USA) is a modified cyclodextrin designed to selectively encapsulate aminosteroidal neuromuscular blocking agents (NMBAs) such as rocuronium and vecuronium, which leads to the rapid reversal of neuromuscular block (NMB).
  • 702
  • 07 Dec 2021
Topic Review
Anaesthesia in Veterinary Oncology
Anaesthesia plays an important role in diagnosis procedures and the treatment and pain management of oncological patients. However, studies suggest that anaesthetic drugs may increase the risk of tumour dissemination in the perioperative period by directly and indirectly suppressing the immune system, which is primarily responsible for controlling tumour growth. 
  • 698
  • 06 Dec 2023
Topic Review
Clinical Applications of Crystalloids within Enhanced Recovery Pathways
Perioperative fluid management, a critical aspect of major surgeries, is characterized by pronounced stress responses, altered capillary permeability, and significant fluid shifts. Recognized as a cornerstone of enhanced recovery protocols, effective perioperative fluid management is crucial for optimizing patient recovery and preventing postoperative complications, especially in high-risk patients. The scientific literature has extensively investigated various fluid infusion regimens, but publications indicate that not only the volume but also the type of fluid infused significantly influences surgical outcomes.
  • 694
  • 21 Sep 2023
Topic Review
Epidural Oxycodone for Acute Pain
Oxycodone is a feasible opioid for epidural analgesia. Pruritus and PONV may be reduced with epidural oxycodone compared to epidural morphine.  Epidural analgesia is commonly used in labour analgesia and in postoperative pain after major surgery. It is highly effective in severe acute pain, has minimal effects on fetus and newborn, may reduce postoperative complications, and enhance patient satisfaction. In epidural analgesia, low concentrations of local anaesthetics are combined with opioids. Two opioids, morphine and sufentanil, have been approved for epidural use, but there is an interest in evaluating other opioids as well. Oxycodone is one of the most commonly used opioids in acute pain management.
  • 692
  • 14 Jun 2022
Topic Review
Necessity of Cardiothoracic Surgical Critical Care Medicine Training
Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. 
  • 680
  • 01 Jan 2023
Topic Review
Role of Brain-Derived Neurotrophic Factor in Chronic Pain
Chronic pain is sustained, in part, through the intricate process of central sensitization (CS), marked by maladaptive neuroplasticity and neuronal hyperexcitability within central pain pathways. Accumulating evidence suggests that CS is also driven by neuroinflammation in the peripheral and central nervous system. In any chronic disease, the search for perpetuating factors is crucial in identifying therapeutic targets and developing primary preventive strategies. The brain-derived neurotrophic factor (BDNF) emerges as a critical regulator of synaptic plasticity, serving as both a neurotransmitter and neuromodulator. Mounting evidence supports BDNF’s pro-nociceptive role, spanning from its pain-sensitizing capacity across multiple levels of nociceptive pathways to its intricate involvement in CS and neuroinflammation.
  • 653
  • 15 Mar 2024
Topic Review
Nociception during Pediatric Surgery
The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Different devices have been marketed to “reliably” detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages.
  • 613
  • 13 Mar 2023
Topic Review
Peripheral Nerve Blocks for Cesarean Delivery Analgesia
Cesarean delivery is the most commonly performed abdominal surgery in the world, and it can be associated with severe postoperative pain. Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. 
  • 611
  • 16 Nov 2023
Topic Review
Blood Inflammatory Biomarkers in Parkinson’s Disease Patients
Parkinson’s disease (PD) is the second most common inflammatory neurodegenerative disorder after dementia. Preclinical and epidemiological data strongly suggest that chronic neuroinflammation slowly induces neuronal dysfunction. Activated microglia secrete several neurotoxic substances, such as chemokines and proinflammatory cytokines, which may promote blood–brain barrier (BBB) permeabilization.
  • 599
  • 17 May 2023
Topic Review
Continuous Interscalene Brachial Plexus Blocks
Brachial plexus blocks at the interscalene level are frequently chosen by physicians and recommended by textbooks for providing regional anesthesia and analgesia to patients scheduled for shoulder surgery. Published data concerning interscalene single-injection or continuous brachial plexus blocks report good analgesic effects. The principle of interscalene catheters is to extend analgesia beyond the duration of the local anesthetic’s effect through continuous infusion, as opposed to a single injection. However, in addition to the recognized beneficial effects of interscalene blocks, whether administered as a single injection or through a catheter, there have been reports of consequences ranging from minor side effects to severe, life-threatening complications. 
  • 595
  • 17 Feb 2024
Topic Review
Pain in Colorectal Surgery
Pain is a complex entity with deleterious effects on the entire organism. Poorly controlled postoperative pain impacts the patient outcome, being associated with increased morbidity, inadequate quality of life and functional recovery.
  • 575
  • 10 Nov 2023
Topic Review
Management of the Pediatric Patient with Special Needs
The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible.
  • 574
  • 11 Oct 2022
Topic Review
Clinical Diagnosis and Treatment of Chronic Pain
Pain medicine is a multidisciplinary and multimodal approach to help patients manage chronic pain. The definition of chronic pain has evolved to become less “non-specific” and to help aid in the proper classification of the disease. While the term can often be too generalized when describing a wide array of conditions, the future of chronic pain diagnosis and treatment is becoming more personalized and precision based. More optimized and specific chronic pain diagnoses can help avoid pooling together heterogenous conditions.
  • 572
  • 29 Dec 2023
Topic Review
Intraoperative Circulatory Support in Lung Transplantation
Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk.
  • 569
  • 28 Jul 2022
Topic Review
The PATIENT Approach
PATIENT (P: patient’s perception; A: assessment; T: tailored approach; I: iterative evaluation; E: education; N: non-pharmacological approach; T: team), a bundle which can help to summarize all the steps to follow in the management of chronic pain.
  • 538
  • 02 Nov 2023
Topic Review
Anesthetics and Cell–Cell Communication
Cell–cell communication via gap junction channels is known to be inhibited by the anesthetics heptanol, halothane and isoflurane; despite numerous studies, the mechanism of gap junction channel gating by anesthetics is still poorly understood.
  • 522
  • 20 Feb 2023
Topic Review
HFOT in the Perioperative Setting and Procedural Sedation
High-flow oxygen therapy (HFOT) is a respiratory support system, through which high flows of humidified and heated gas are delivered to hypoxemic patients.
  • 522
  • 07 Nov 2023
Topic Review
Novel Cellular and Immunotherapy
Targeted cellular and immunotherapies have welcomed a new chapter in multi-modal cancer therapy. These agents harness our innate immune system and destroy malignant cells in a precise way as compared with “legacy” chemotherapeutic agents that largely rely on abolishing cell division. New therapies can augment the T-cell recognition of tumor antigens and effectively prevent tumor cells from their historically successful ability to evade immune recognition. These novel agents cause acute and chronic toxicities to a variety of organ systems (enteritis, pneumonitis, hypophysitis, and hepatitis), and this may masquerade as other chronic illnesses or paraneoplastic effects. As the perioperative footprint of cancer patients increases, it is essential that perioperative providers—anesthesiologists, surgeons, nurse anesthetists, and inpatient hospital medicine providers—be up to date on the physiologic mechanisms that underlie these new therapies as well as their acute and subacute toxicity profiles. Immunotherapy toxicity can significantly impact perioperative morbidity as well as influence perioperative management, such as prophylaxis for adrenal insufficiency, preoperative pulmonary assessment, and screening for thyroid dysfunction, among others.
  • 518
  • 24 Aug 2023
Topic Review
The Omics Complexity in Sepsis
Sepsis is one of the most common causes of morbidity and mortality worldwide. Despite the remarkable advances in modern medicine throughout the last century, the mortality rates associated with sepsis have remained significantly elevated, both in high- and low-income countries. The main difficulty in the diagnosis and treatment of septic patients is the tremendous heterogeneity of this condition. 
  • 467
  • 11 Mar 2024
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